Orientador: Clélia Akiko Hiruma-Lima / Banca: Luiz Cláudio Di Stasi / Banca: Alessandra Gambero / Banca: Marcelo Aparecido da Silva / Banca: Noeli Pereira Rocha / Resumo: A doença inflamatória intestinal (DII) corresponde a um conjunto de desordens crônicas inflamatórias intestinais, de etiologia ainda desconhecida, sendo a retocolite (RCU) e a doença de Crohn (DC) as duas doenças mais representativas e de maior importância clínica. Devido a pouca eficácia das terapias convencionais, muitos pacientes recorrem a métodos alternativos, como o uso de plantas medicinais. As espécies Davilla elliptica St. Hil e Davilla nitida (Vahl) Kubitzki (família Dilleniaceae) são plantas arbustivas comumente encontradas no Cerrado brasileiro. D. elliptica, conhecida como lixeirinha, é utilizada na medicina popular para o tratamento de afecções do trato gastrointestinal, como úlceras e gastrites, e também utilizado como antiinflamatório. D. nitida (cipó de fogo) apresenta um grande potencial para o tratamento de doenças do trato gastrointestinal, pois semelhante a D. elliptica, apresenta comprovada ação gastroprotetora e ambas possuem perfis fitoquímicos semelhantes, compostos basicamente de polifenóis. Os objetivos deste trabalho foram avaliar os efeitos preventivos e/ou curativos dos extratos metanólicos de D. elliptica (EDE) e D. nitida (EDN) em modelos experimentais de colite (agudo e crônico) induzidos pelo ácido trinitrobenzenosulfônico (TNBS) em ratos e os possíveis mecanismos decorrentes dessas ações farmacológicas. A partir dos resultados anteriormente obtidos da ação gastroprotetora de ambos os extratos, foram selecionadas as doses empregadas nos modelos experimentais de colite. Foi constatado que altas doses (500 mg/kg) de EDE e EDN administradas oralmente, promovem o agravamento das injúrias no cólon (aumento de 47 e 21% das lesões, respectivamente). Porém, ao avaliar os efeitos agudos de ambos os extratos no modelo de colite com doses menores (31.2, 62.5 e 125 mg/kg), ocorreram reduções significativas das áreas... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Inflammatory bowel disease (DII) represents a group of chronic inflammatory bowel disorders of unknown etiology, and ulcerative colitis (RCU) and Crohn's disease (DC) both diseases are most representative and important among the DII clinic. Because the conventional therapies ineffectiveness, many patients resort to alternative methods, such as the use of medicinal plants. The species Davilla elliptica St. Hil and Davilla nitida (Vahl) Kubitzki (family Dilleniaceae) are shrubs commonly found in the Brazilian Cerrado. D. elliptica, known as "lixeirinha", is used in folk medicine for the gastrointestinal disorders treatment such as gastritis and ulcers and also used as antiinflammatory. D. nitida ("cipó de fogo") has great potential to treat gastrointestinal diseases, thus similar to D. elliptica, has proven gastroprotective action and both have similar phytochemical profiles, composed primarily of polyphenols. Our objectives were to evaluate the preventive and/or healing effects of the D. elliptica (EDE) and D. nitida (EDN) methanolic extracts in the colite experimental models (acute and chronic) induced by trinitrobenzenesulfonic acid (TNBS) in rats and possible mechanisms resulting from these pharmacological actions. From the previous results of gastroprotective action of both extracts, we selected the doses used in experimental models of UC. It was found that high doses (500 mg / kg) of EDN and EDE administered orally, promoted the colon injury aggravation (lesion increasing of 47 and 21%, respectively). However, in assessing the acute effects of both extracts in the UC model at lower doses (31.2, 62.5 and 125 mg/kg), there were significant reductions in areas (for both extracts) and scores of the injuries (EDN only) promoted by TNBS. The colonic lesions reduction in the animals treated with EDE and EDN did not alter the weight/length parameter of colon and feed... (Complete abstract click electronic access below) / Doutor

Orientador: Luiz Claudio Di Stasi / Banca: Leonardo Noboru Seito / Banca: Claudia Helena Pellizon / Resumo: A Doença Inflamatória Intestinal (DII) é uma doença com etiologia desconhecida e sem terapêutica curativa disponível, englobando, fundamentalmente, duas doenças distintas: a Doença de Crohn (DC) e a Retocolite Ulcerativa (RCU), ambas caracterizadas por uma inflamação crônica do intestino, com períodos de exacerbação seguidos de intervalos prolongados com remissão dos sintomas, cujo tratamento com os fármacos disponíveis apresentam sérios efeitos colaterais. Portanto, o desenvolvimento de novas estratégias de tratamento que combinem eficácia e segurança é uma importante meta na terapia da DII, sendo que as plantas medicinais são indispensáveis fontes de novos compostos de valor terapêutico. Physalis angulata L. é uma planta nativa brasileira que cresce especialmente nas regiões norte e nordeste do Brasil e em outros países tropicais da África, América e Ásia, sendo amplamente utilizada pela população para o tratamento de uma série de doenças, especialmente aquelas que possuem características inflamatórias. Estudos in vitro em culturas de células realizados por nosso grupo de pesquisa, somados aos dados descritos na literatura mostram que a P. angulata é capaz de modular vários mediadores inflamatórios. Dessa forma, o objetivo deste trabalho foi avaliar a atividade anti-inflamatória intestinal do extrato padronizado em fitoesteróis totais de P. angulata, nas fases aguda e crônica (com recidiva) do processo inflamatório intestinal induzido por acido trinitrobenzenosulfônico (TNBS) em ratos. Os resultados obtidos mostraram, pela primeira vez, que o extrato padronizado produziu uma série de efeitos que melhoraram a resposta dos animais frente à lesão intestinal promovida pelo TNBS. Estes efeitos foram mais pronunciados nos estudos de fase aguda, indicando uma propriedade preventiva importante... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Inflammatory Bowel Disease (IBD) is a disease with unknown etiology and no curative treatment available, embracing essentially two distinct diseases: Crohn's disease (CD) and ulcerative colitis (UC), both characterized by chronic inflammation of the intestine, with periods of exacerbation followed by long intervals with symptom remission, whose treatment with available drugs have serious side effects. Therefore, the development of new treatment strategies that combine effectiveness and safety is an important goal in the treatment of IBD, where medicinal plants are sources of essential novel compounds of therapeutic value. Physalis angulata L. is a native Brazilian plant that grows especially in Northern and Northeastern Brazil and other tropical countries of Africa, America and Asia and is widely used by people to treat a number of diseases, especially those with inflammatory characteristics. In vitro studies in cell cultures conducted by our research group, combined with the previously reported data, show that P. angulata is capable of modulating several inflammatory mediators. Thus, the objective of this study was to evaluate the intestinal anti-inflammatory activity of P. angulata standardized extract in total phytosterols, in the acute and chronic (with relapse) phases of the intestinal inflammatory process induced by trinitrobenzene sulfonic acid (TNBS) in rats. The results showed, for the first time, that the standardized extract produced a series of effects that improved the response of animals against intestinal injury promoted by TNBS. These effects were more pronounced in the acute studies, indicating an important preventive property by reducing the activity of myeloperoxidase and alkaline phosphatase, in addition with the ability of the extract to prevent depletion of glutathione induced by intestinal... (Complete abstract click electronic access below) / Mestre

Conselho Nacional de Desenvolvimento CientÃfico e TecnolÃgico / IntroduÃÃo: A mucosite induzida por antineoplÃsicos à um fator limitante na terapia anticÃncer. Mucosite à um termo clÃnico que descreve uma sÃndrome caracterizada por ulceraÃÃo da mucosa de todo o trato digestivo. O trato gastrintestinal à vulnerÃvel por causa da alta proliferaÃÃo e freqÃÃncia de renovaÃÃo celular. Assim, a mucosite intestinal resulta de eventos inflamatÃrios, que levam as alteraÃÃes de permeabilidade e trÃnsito intestinal e de alteraÃÃes na motilidade intestinal tanto na fase inflamatÃria, como na fase pÃs-inflamatÃria. Pentoxifilina (PTX) à um importante inibidor da sÃntese de citocinas, alÃm de apresentar efeito protetor sobre a mucosite oral por 5-FU em hamster. A dexametasona (DEXA) à um glicocorticÃide cujo principal efeito farmacolÃgico decorre de sua aÃÃo antiinflamatÃria e imunossupressora. Objetivos: Avaliar o efeito do tratamento com pentoxifilina ou dexametasona na resposta inflamatÃria e nas alteraÃÃes da motilidade digestiva associadas a mucosite intestinal experimental induzida por 5-FU. MÃtodos: Ratos Wistar machos (200 â 250g) foram tratados no d0 com 5-FU (150 mg/Kg, i.p. dose Ãnica) ou com 5-FU + PTX (90mg/Kg, s.c.) ou 5-FU + DEXA (2,5mg/Kg, i.p.). A PTX e a DEXA foram administradas meia hora apÃs a administraÃÃo de 5-FU no d0 e diariamente atà o sacrifÃcio. No d3 os animais foram sacrificados, amostras do duodeno, jejuno e Ãleo, foram removidas para avaliar a injÃria epitelial por morfometria, escores histolÃgicos, pela atividade de MPO e pela concentraÃÃo de GSH. Para avaliaÃÃo de citocinas amostras de duodeno foram retiradas e pelo mÃtodo de ELISA foi determinada a concentraÃÃo de TNF- e IL-1 e pela imunohistoquÃmica foi observado a imunomarcaÃÃo. Jà na tÃcnica de esvaziamento gÃstrico os animais receberam o mesmo tratamento descrito anteriormente. Posteriormente, foram deixados em jejum de 18 horas do d2 para o d3. No d3, foram administrados 1,5 ml da soluÃÃo glicosada (5%) contendo vermelho de fenol (VF) a 0,75 mg/ml em cada animal. ApÃs 20 min, os animais foram sacrificados e submetidos a uma laparotomia mediana. O intestino delgado foi exposto e divido em 3 partes iguais: proximal, medial e distal. Com o auxÃlio de uma proveta contendo uma soluÃÃo de NaOH (100ml, 0,1N) o volume do estÃmago e dos segmentos do intestino delgado foram determinados. A absorbÃncia da amostra foi lida sob um comprimento de onda de 540 nm. Resultados: O tratamento com 5-FU foi capaz de induzir uma lesÃo intestinal com um importante comprometimento da barreira epitelial funcional com a presenÃa das seguintes alteraÃÃes: encurtamento acentuado das vilosidades intestinais, necrose parcial de criptas, vacuolizaÃÃo de cÃlulas, presenÃa de infiltrado mono e polimorfonucleares, produÃÃo de radicais livres com consumo de GSH, aumento na concentraÃÃo de TNF- e IL-1 com maior imunomarcaÃÃo (no duodeno) e alteraÃÃes na motilidade digestiva. O tratamento com DEXA e PTX reduziu significativamente as lesÃes intestinais, com recuperaÃÃo da altura dos vilos, recuperaÃÃo da profundidade das criptas, diminuiÃÃo do infiltrado neutrofÃlico, aumento dos nÃveis de glutationa e reduÃÃo da concentraÃÃo de TNF-, IL-1 com uma menor imunomarcaÃÃo. Contudo somente o tratamento com DEXA foi capaz de reverter o retarde do esvaziamento gÃstrico e do transito gastrintestinal. ConclusÃo: 5-FU induz mucosite intestinal em ratos com a participaÃÃo de TNF- e IL-1, a qual se associa com retarde no esvaziamento gÃstrico e no transito gastrintestinal. O tratamento com PTX ou DEXA foram capaz de reverter parte dos achados inflamatÃrios, entretanto, somente o tratamento com DEXA foi capaz de reverter parcialmente Ãs alteraÃÃes na motilidade digestiva associadas a mucosite por 5- FU em ratos. / Introduction: One of the most important limitation of antineoplasic chemotherapy is the intestinal mucositis. Mucositis is a clinical term wich describes a syndrome characterized for ulceration in the digestive tract. Gastrointestinal tract is vulnerable because it have elevated proliferation cellular renovation. Intestinal mucositis results in inflammatory events, that leads the alterations in permeability and gastrointestinal motility in the inflammatory phase, as in the post-inflammatory phase. Pentoxifylline (PTX) is important inhibitor of the cytokines synthesis, with a protective effect against 5-FU- induced oral mucositis in hamster. Dexamethasone (DEXA) is glucorticoide with anti-inflammatory and immunosuppressive effects. Aim: To evaluate the effect of the pentoxifylline or dexamethasone treatments in the inflammatory response and alterations of the gastrointestinal motility associate with 5-FU- induced intestinal mucositis. Methods: Male Wistar rats (200 â 250g) treated in d0 by 5-FU (150 mg/Kg, i.p. only dose) or 5-FU + PTX (90 mg/Kg, s.c.) or 5-FU + DEXA (2.5mg/Kg, i.p.). PTX or DEXA were administrated 30â after 5-FU, and then daily. In d3, animals were sacrificed, samples duodenum, jejunum and ileum were removed for assessment epithelial damage for morphometric, histological scores, MPO activity and GSH concentration. In order to evaluate the concentration of TNF- and IL-1, duodenum samples were removed and ELISA or imunohistoquimic for this cytocines were performed. In order to evaluated the gastrointestinal motility, animals received same treatment described previously, then were fasted for 18h of the d2 to d3. In d3 the animals were gavage-fed with a test meal and sacrificed 20 min later. Stomach and consecutive intestinal segments same (proximal, medial and distal) were obtained. Each segment was placed in a measuring cylinder and the volume measured by adding 100 mL of 0.1 NaOH. The absorbance of the sample was read at a 540 nm. Results: The treatment with 5-FU induced intestinal damage with an important disruption of the functional epithelial barrier and presence of these following alterations: shortening villus, partial necrosis crypts, vacuolated cells, presence of infiltrated mono and polymorphonuclears, production of free radicals with GSH consumption, increase in the concentration of TNF- and IL-1 in the duodenum, and gastrointestinal dismotility. The treatment with DEXA and PTX significantly reduced the intestinal damage, with recovery of the high villus, depth of crypt, reduction of the neutrophil infiltration, increase of the levels of glutathione and reduction in the TNF- and IL-1 concentrations. However, only the treatment with DEXA was able to reverse the delays gastric emptying and gastrointestinal transit induced by intestinal mucositis. Conclusion: 5-FU induces intestinal mucositis in rats with the participation of TNF- and IL-1. It associates with delayed gastric emptying and gastrointestinal transit. We conclude also that PTX or DEXA- treatments decreases the inflammatory response. On the other hand, only DEXA treatment reversed gastrointestinal dismotility associate with 5â FU- induced intestinal mucositis in rats.

A Doença de Crohn (CD) e a Colite Ulcerativa (UC) são as principais enfermidades componentes das Doenças Inflamatórias Intestinais (DII). Embora existam vários medicamentos atualmente empregados para atenuar a inflamação descontrolada no intestino, tratar as complicações ou prolongar os períodos de remissão clínica, não há, ainda, uma terapia que seja totalmente efetiva para estas doenças. Os glicocorticoides (GCs), anti-inflamatórios comumente usados nas DII, possuem eficácia limitada e mais da metade dos pacientes se tornam refratários ou dependentes da medicação. Por outro lado, as estatinas são conhecidas por possuírem propriedades pleiotrópicas e seu uso concomitante com os GCs tem gerado boas perspectivas em várias doenças autoimunes e inflamatórias, inclusive nas DII. Apesar de já existirem indicativos de melhora de pacientes com DII pela utilização combinada destas drogas, ainda há escassez de dados que mostrem as alterações causadas no sistema imunológico. Assim, o objetivo desse trabalho foi avaliar os efeitos imunomoduladores do uso concomitante de GCs e estatinas na colite experimental induzida por dextran sulfato de sódio (DSS) em camundongos C57BL/6. Os resultados mostraram que o uso contínuo de GCs (dexametasona - DX), associados ou não a estatinas (atorvastatina - ATO), não alterou o curso da doença e antecipou a morte dos camundongos, enquanto que o oposto foi observado com o uso isolado de ATO. Tratamentos em curto prazo (3 doses) contendo ATO (isolada ou associada à DX) causaram melhora clínica e histológica dos animais doentes, diminuíram o número de leucócitos circulantes (principalmente monócitos) e de células mononucleares na lâmina própria (LP), a frequência de células CD11b+ na LP, a frequência de células dendríticas (DCs) CD11b+CD11c+ e CD11b-CD11c+ no baço e a frequência de células CD4+ produtoras de IFN- nos linfonodos mesentéricos (LNM). Entretanto, ambos os esquemas terapêuticos aumentaram a frequência de linfócitos T CD8+ no baço e LNM. Ainda, as terapias inibiram a proliferação de esplenócitos tratados in vitro, diminuíram a síntese de IL-6 e, quando em baixas concentrações, aumentaram a produção de IL-10. Diferencialmente, o tratamento combinado pareceu exercer os efeitos acima descritos de modo mais pronunciado do que o uso isolado de estatina. Adicionalmente, diminuiu os níveis de expressão de RNAm das citocinas IL-1, IL-17 e IFN- no local da inflamação, reduziu o número de linfócitos circulantes, de leucócitos no baço e LNM e de linfócitos T CD4+ nos LNM, além de ter aumentado a frequência de DCs CD11b-CD11c+ na LP e a concentração de Fas-L no intestino grosso. Considerando o uso em curto prazo com ATO isolada, foi observado aumento da frequência de DCs CD11b-CD11c+ nos LNM e de células Natural killer (NK) no baço dos camundongos doentes e diminuição dos níveis de expressão de RNAm de PPAR- no intestino grosso. O uso isolado de DX em curto prazo melhorou os aspectos histológicos, diminuiu o número de macrófagos e os níveis de IFN- no cólon, diminuiu o número de leucócitos circulantes (principalmente linfócitos), aumentou a frequência de células CD11b+ no baço e a síntese de IL-10 por esplenócitos ex vivo. Apesar da frequência de células T reguladoras (Treg) e da susceptibilidade dos esplenócitos à sinais reguladores não terem sido modificados após os diferentes tratamentos, nossos resultados sugerem que as estatinas usadas isoladamente preservaram a resposta inflamatória do organismo de modo eficiente e controlado, enquanto que o uso associado das drogas causou a imunossupressão dos animais doentes, contribuindo para as complicações clínicas decorrentes da colite experimental induzida por DSS. / Crohn\'s disease (CD) and Ulcerative colitis (UC) are the main conditions that comprise the Inflammatory Bowel Diseases (IBD). The conventional drug therapies for IBD aim to attenuate the uncontrolled inflammation in the intestinal mucosa, to treat the complications and to extend clinical remission. However, all available drugs have unpredictable or limited effects. Glucocorticoids (GCs) are commonly anti-inflammatory drugs, which are associated to refractoriness and/or dependence in over half of IBD patients. On the other hand, statins have pleiotropic properties and the concomitant use with GCs has shown good prospects in several autoimmune and inflammatory diseases, including IBD. Despite the putative clinical improvement after combined use of GCs and statins in IBD, there is a lack of data indicating their additive effects on the immune system. Therefore, the purpose of this study was to evaluate the immune modulatory effects of the concomitant use of statins and GCs in experimental colitis induced by dextran sulfate sodium (DSS). The results showed that long-term use of GCs (dexamethasone - DX), alone or associated to statins (atorvastatin - ATO), did not improve the clinical signs and increased the death rates of C57BL/6 mice exposed to DSS, while the opposite was observed after treatment with statins alone. Short-term use of ATO (3 doses), alone or associated to DX, improved the clinical signs and histological parameters in DSS-exposed mice, decreased the number of white blood cells (mainly monocytes), the number of mononuclear cells in the lamina propria (LP), the frequency of CD11b+ cells in the LP, the frequency of CD11b+CD11c+ and CD11b-CD11c+ dendritic cells (DCs) in the spleen and the frequency of IFN--producing CD4+ T cells in the mesenteric lymph nodes (MLN). However, ATO alone or associated to DX lead to increased CD8+ T lymphocytes in the spleen and MLN. Moreover, both therapies containing ATO inhibited the proliferation of in vitro-treated splenocytes, besides decreasing IL-6 and increasing IL-10 synthesis. Differentially, the association of drugs led to a more pronounced effects over the changes mentioned above than the single use of statin and additionally decreased IL-1, IL-17 and IFN- mRNA expression levels at the intestinal tissue, the number of circulating lymphocytes, the number of leukocytes in spleen and MLN and the frequency of CD4+ T lymphocytes in the MLN. In addition, statins and GCs increased the frequency of CD11b-CD11c+ DCs in LP and the Fas-L concentrations in the large intestine. Considering the short-term use of ATO there was increased frequency of CD11b-CD11c+ DCs in MLN, increased frequency of natural killer (NK) cells in the spleen and decreased mRNA expression of PPAR- in the large intestine. The short-term use of DX improved the histology parameters, decreased the number of macrophages and IFN- levels in the colon, reduced the number of circulating leukocytes (mainly lymphocytes), and increased the frequency of CD11b+ cells in spleen and IL-10 synthesis by ex vivo splenocytes. Finally, since both regulatory T cells (Treg) frequency and the splenocytes susceptibility to regulatory signals have not been modified after the different treatments, our findings suggest that single use of statins preserved an efficient and controlled inflammatory response, while the combined use of GCs and statins led to immunosuppression, which probably contributed to long-term clinical complications of DSS-induced colitis.

Introdução: Os idosos representam um segmento demográfico crescente tanto nos países desenvolvidos como nos em desenvolvimento. A constipação intestinal é um sintoma relatado por 24 a 40% desses indivíduos, afetando 26% dos homens e 34% das mulheres. O consumo de uma dieta rica em fibras alimentares e líquidos ajuda na diminuição das queixas relacionadas à constipação intestinal funcional. Os idosos necessitam de atenção especial com intervenções dietéticas diferenciadas por meio de ações educativas específicas. Objetivo: Analisar os efeitos do aconselhamento nutricional centrado no cliente, em idosos com constipação intestinal funcional matriculados em ambulatório geriátrico. Métodos: O estudo foi experimental do tipo ensaio clínico aleatorizado realizado entre abril de 2002 e novembro de 2003. Os idosos foram alocados em grupo intervenção (n=19) e controle (n=21) e os dois grupos participaram de sete consultas mensais. O aconselhamento nutricional centrado no cliente foi o modelo educativo adotado nas consultas com o grupo intervenção. Esse modelo considera a educação como o processo de ensino, treinamento e facilitação, que permite a troca de informações entre o educador e o educando, por meio de uma linguagem entendível, dentro de um ambiente que conduz ao aprendizado. As variáveis analisadas foram: Índice de Massa Corporal (IMC), prática de atividade física, consumo alimentar (energia, carboidratos, lipídios, grupo das frutas, das leguminosas, ingestão de líquidos, grupo dos cereais, consumo de fibras alimentares), uso de medicamentos total e laxante e as queixas que caracterizam a constipação intestinal funcional. O consumo alimentar foi avaliado pelo recordatório de 24 horas em medidas caseiras e a atividade física pelo Questionário de Baecke. Os dados foram analisados por meio da Análise de Variância de Medidas Repetidas (paramétrica ou não paramétrica) e método de Bonferroni. O nível de significância adotado para os testes foi de 5%. Resultados: Os idosos mais jovens do grupo controle eram mais pesados que os mais velhos desde o início do acompanhamento (p=0,001) e os dois grupos não alteraram a prática de atividade física. O grupo intervenção aumentou o consumo de líquidos a partir da quarta consulta até o final do seguimento quando comparado à entrevista inicial (p=0,031) e, no que se refere à ingestão de leguminosas, observou-se aumento no consumo na quarta (p=0,028) e sexta (p=0,042) consultas na comparação intergrupos. Em relação ao uso de medicamentos total, tanto o grupo controle quanto o grupo intervenção não modificaram seu consumo (p=0,650), por outro lado, o grupo controle consumiu mais laxantes durante o acompanhamento quando comparado ao grupo intervenção (p=0,018). Os dois grupos apresentaram redução das queixas que caracterizam a constipação intestinal funcional durante o seguimento. Conclusões: Os resultados desse estudo indicam que o aconselhamento centrado no cliente é eficaz como uma abordagem educativa para a mudança de comportamento alimentar e conseqüente diminuição das queixas intestinais que caracterizam a constipação intestinal funcional. / Introduction: The elderly represent a growing demographic line not only in the developed countries but also the ones in developing. The bowel constipation is a related symptom for 24 to 40% of those persons, affecting 26% men e 34% women. The consumption of diet full in dietary fibers and liquids helps on decreasing of claims related to functional intestinal constipation. The elderly need to a special attention with diversified dietetics intervention through specific educated actions. Objective: Analyze the effects of client-centered nutritional counseling, in elderly with functional bowel constipation enrolled in geriatric ambulatory. Methods: The studying was experimental as a randomized clinic trial carried out between April 2002 and November 2003. Elderly were assigned in intervention group (n=19) and control (n=21) and both groups participated of seven consults, one per month. The client-centered nutritional counseling was the educating model adopted in consults with the intervention group. That model takes into account the education as the process of teaching, training and make it easy, that allows the changing of information between the educator and the student through understanding language inside of a place that lead to learning. The variables analyzed were: Body Mass Index (BMI), practice of physical activity, food intake (energy, carbohydrate, lipids, group of fruits, group of leguminous, ingestion of liquids, group of cereals, intake of dietary fibers), using of total drugs and laxatives and the claims that characterizes the functional bowel constipation. The food intake was evaluated with 24 hours recall on household measures and the physical activity by Baecke Questionnaire. The data were examined critically through Analyses of Variance With Repeated Measures (parametric and non-parametric) and Bonferroni's method. The significance level adopted to the tests was 5%. Results: The youngest elderly of control group were heavier than the oldest since the beginning of accompanying (p=0,001) and both group didn't change the practicing of physical activity. The intervention group increased the consumption of liquids since of fourth consult up the ending of segment when compared with initial interview (p=0,031) and, in what refers to ingestion of leguminous, it was observed an increasing in consumption in forth (p=0,028) and sixth (p=0,042) consults in the comparing between the groups. Relating the using of total drugs, not only the control group but also intervention group didn't change their consumption (p=0,650), on the other hand, the control group consumed more laxatives during the accompanying when compared to intervention group (p=0,018). Both groups presented reduction of claims that characteristic the functional bowel constipation during the segment. Conclusions: The results of that studying indicate that the client-centered counseling is efficient as an educative approach to the changing of alimentary behavior and consequent reduction of intestinal claims that characterize the functional bowel constipation.

D’étiologie inconnue, les maladies inflammatoires chroniques de l’intestin, telles que la maladie de Crohn ou la rectocolite hémorragique, semblent résulter d’une réaction immunitaire inappropriée vis-à-vis de la flore commensale chez des individus génétiquement prédisposés. De ce fait, la modulation du microbiote par des probiotiques, majoritairement des bactéries lactiques commensales (lactobacilles et bifidobactéries), représente une alternative thérapeutique intéressante et a déjà conduit à un certain nombre d’essais cliniques concluants. Cependant, les effets thérapeutiques des bactéries probiotiques se sont avérés spécifiques de la souche utilisée et les mécanismes d’action de ces micro-organismes restent encore méconnus. Dans cette étude, nous nous sommes intéressés au rôle du peptidoglycane et de la voie de signalisation NOD2 dans les capacités anti-inflammatoires de certains lactobacilles probiotiques. Dans un modèle murin de colite expérimentale mimant la pathologie humaine, nous avons tout d’abord montré que les capacités protectrices de la souche anti-inflammatoire Lactobacillus salivarius Ls33 nécessitent la présence du récepteur NOD2. Ce récepteur reconnaissant les produits de dégradation du peptidoglycane, nous avons préparé du peptidoglycane hautement purifié de la souche Ls33 et montré que l’administration de ce composant, par voie intrapéritonéale ou orale, protège les souris de la colite expérimentale. Nous avons également mis en évidence que l’effet protecteur du peptidoglycane de Ls33 implique la production d’IL-10, la voie immunosuppressive de l’indoleamine 2,3-dioxygénase et le développement, au sein des ganglions mésentériques, de cellules dendritiques régulatrices CD103+ et de cellules T régulatrices CD4+FoxP3+. Nous avons montré que le peptidoglycane de Ls33 favorise, in vitro, la différentiation de cellules dendritiques naïves en cellules dendritiques productrices d’IL-10, capables de protéger, après transfert adoptif, les souris de la colite de façon NOD2-dépendante. Les capacités protectrices n’ayant pas été obtenues avec le peptidoglycane de la souche non anti-inflammatoire L. acidophilus NCFM, nous avons ensuite réalisé une analyse structurale des deux peptidoglycanes. Alors que les deux souches arborent le muropeptide M-tri-Lys-D-Asn, nous avons identifié un muropeptide additionnel libéré uniquement par Ls33, le M-tri-Lys. Bien que les deux muropeptides synthétiques activent NOD2 in vitro, seule l’administration systémique du M-tri-Lys protège les souris de la colite. Cette protection est dépendante du récepteur NOD2 mais ne nécessite pas la présence de l’adaptateur principal des récepteurs de type Toll ou TLR, MyD88. En conclusion, nos résultats indiquent que le peptidoglycane et certains de ses dérivés sont des composants actifs dans la fonctionnalité des lactobacilles probiotiques et représentent une nouvelle stratégie thérapeutique pour le traitement des maladies inflammatoires chroniques de l’intestin. / N genetically susceptible individuals, an inappropriate mucosal immune responseagainst the intestinal microbiota appears to be the principal mechanism leading to thepathogenesis of (including Crohn’s disease and ulcerativecolitis). Therefore, modulation of the luminal contents with probiotics, mainly represented bycommensal lactic acid bacteria (lactobacilli and bifidobacteria), represents an attractivetherapeutic alternative and has already led to successful clinical trials. However, theprotective effect of probiotic bacteria clearly depends on the strains used and the precisemechanisms of action of these microorganisms are still unknown.In this study, we investigated the role of peptidoglycan and NOD2 signalling in the antiinflammatorycapacity of selected probiotic lactobacilli.In a mouse model of experimental colitis mimicking human pathology, we first showedthat the protective capacity of the anti-inflammatory strain Lactobacillus salivarius Ls33require NOD2 signalling. Since this receptor senses peptidoglycan degradation products, weprepared highly purified peptidoglycan from Ls33 and showed that systemic as well as oraladministration of this component was able to rescue mice from experimental colitis. We alsodemonstrated that the protective effect of Ls33 peptidoglycan involved the production of IL-10, the immunosuppressive indoleamine 2,3-dioxygenase pathway and the expansion ofregulatory CD103+ dendritic cells and CD4+FoxP3+ regulatory T cells within mesentericlymph nodes. Furthermore, we showed that the IL-10-producing dendritic cells induced byLs33 peptidoglycan in vitro were able to protect mice from colitis in a NOD2-dependentmanner after adoptive transfer.Since the observed anti-inflammatory properties were not obtained with peptidoglycanderived from the non-anti-inflammatory strain L. acidophilus NCFM, we conducted astructural analysis of the two peptidoglycans. While the two strains exhibited the M-tri-Lys-DAsnmuropeptide, we identified an additional muropeptide released exclusively by Ls33, theM-tri-Lys. Although both synthetic muropeptides activated NOD2 in vitro, only systemicadministration of M-tri-Lys protects mice from colitis. This protective effect was NOD2-dependent but did not require the presence of MyD88, the main adapter used by Toll-likereceptors.In conclusion, our results indicate that purified peptidoglycan and specific derivedmuropeptides are active components in probiotic lactobacilli functionality and represent anew therapeutic strategy for treating inflammatory bowel diseases.

Abdominal pain of non-visceral origin has been recognised as a clinical entity for many years. In many gastroenterology clinics up to 50 per cent of patients attending have no pathological cause to their symptoms and such patients often become chronic attenders and suffer repeated investigation without resolution of their problem. They are often left with a label' of Irritable Bowel Syndrome (lBS) without a precise diagnosis being made. This is both unsatisfactory for the patient and physician. This study set out to determine the incidence of musculoskeletal causes of abdominal pain and to determine what diagnostic tools will help identify this group of patients and thus allow the physicians to refer the appropriate patients at an early stage. The aims were to identify questions that act as predictors of the presence of abdominal pain of musculoskeletal origin, patterns of pain presented in this group of patients and the ability of physiotherapists to detect cases of abdominal pain of musculoskeletal origin. The incidence of abdominal pain of musculoskeletal origin in this study was 14 per cent. Questions that act as predictors include an affirmative response to pain being aggravated by movements such as bending, twisting and turning, and coughing and sneezing, and a negative response to change in bowel habit, symptoms being aggravated by food and no weight change. The ability of the physiotherapist to detect cases was 88.3 per cent. No particular pattern of pain areas emerged to differentiate patients with abdominal pain of visceral and musculoskeletal causes. Early assessment of the musculoskeletal system by a trained physiotherapist is recommended. An early referral will lead to prompt and appropriate treatment and, consequently, to a reduction in costs for the NHS. For patients where the cause of their abdominal pain is not obvious it is unacceptable that they are left with the diagnosis of IBS without the musculoskeletal system being assessed. This study shows that such an assessment is vital to detect cases where the pain has a musculoskeletal origin.

No description available.

No description available.

Background: When patients suffer from sicknesses such as rectal cancer, Chrons disease and ulcerative colitis, then ostomies can be a course of treatment. Earlier research show that nurses lack knowledge to be able to care for patients with ostomies while expected to have an important role in the patients’ well-being.  Problem: Lack of knowledge from the general nurse about ostomy care impacts patients since their lives are affected by living with a stoma.  Aim: To describe patient´s experiences of living with a stoma. Method: A literature review based on ten qualitative scientific articles with descriptive synthesis. Results: Experiences shown in the results were divided into three themes: “Emotionell influence”, “Changes in everyday life” and “Acceptance of living with a stoma”.  Out of these themes came six subthemes: “To feel worry”, “To feel frustration”, “To feel shame”, “To live with a changed body”, “To be limited physically in one´s life”, “To lose control”.  Conclusion: Life with a stoma brings daily changes and influences the patients emotional state in relation to their body and their new situation. These experiences can in their turn evolve and patients can come to accept the stoma over time. Patients experiences a lack of information concerning ostomy care and support in living with a stoma. The results show that patients due to their ostomy experience suffering related to illness, to care, and to life.